A Caesarean birth can only be performed on the Central Delivery Suite at Southmead Hospital. A Caesarean birth is an operation that requires a cut to be made in your lower abdomen and uterus (womb) to deliver your baby. The medical term for a Caesarean birth is Caesarean section.
Caesarean births are either planned in advance – an elective Caesarean birth, or become necessary as a result of a problem occurring during your pregnancy or labour – an emergency Caesarean birth.
There are many reasons why a Caesarean birth may be planned and these include:
Previous Caesarean birth - between six and eight out of 10 women who have had one previous Caesarean birth who go into labour in their next pregnancy will achieve a vaginal birth. You will be referred to an obstetrician who will discuss your options for delivery during this pregnancy.
Breech presentation – this is when your baby lies with its bottom and/or feet pointing downwards in your uterus at term, research has shown that it is safer for your baby to be born by a Caesarean birth. It may be appropriate for your obstetrician to suggest attempting to turn your baby into the head down position (External Cephalic Version (ECV)) to avoid having a Caesarean birth, but if this is unsuccessful or you decide not to have this done, then a Caesarean birth would be recommended.
Placenta praevia or low lying placenta (afterbirth) - although it is common for your placenta to be situated in the lower part of your uterus (womb) at your 20 week anomaly scan, it is rare for it still to be low by the time your baby is due to be born. If this is the case, and your placenta is covering the opening of the cervix (neck of your womb) then a vaginal birth would not be possible.
Twins/multiple births - if you are expecting more than one baby you may be offered a Caesarean birth but each case is different and not all twins need to be born by Caesarean.
Very large baby - occasionally for some very large babies, you may be offered a Caesarean birth. This is more common in mothers with diabetes.
Problems with your previous vaginal birth - there may have been problems with your previous vaginal birth, which may reoccur, in subsequent births. If you previously had a vaginal birth but had difficulty delivering your baby’s shoulders (shoulder dystocia) or sustained a perineal (4th degree) tear (skin and muscle between vagina and rectum) that extended down to your rectum (back passage), it is important that you discuss with your obstetrician options for delivery this time.
Medical conditions in the mother - there are a few medical conditions where it may be safer for a woman to have a Caesarean birth rather than go into labour and/or have a vaginal birth. If you have a medical condition, your obstetrician will discuss the best options for delivery with you.
Request by a mother - if you have no medical conditions or problems with your pregnancy or labour that might indicate that a Caesarean birth is necessary, but think you might prefer to have a Caesarean birth rather than a vaginal birth, this can be discussed with your midwife and obstetrician. As a Caesarean birth is a major operation associated with more complications then a vaginal birth, maternal request is not an indication on its own for a Caesarean birth. Therefore it is important that all your reasons for this request are discussed. We have specialists that can support you with anxieties that you may have. It is important to discuss this with your community midwife who could refer you for this help.
Having an elective (planned) Caesarean birth
Caesarean births usually take place in the 39th week. A doctor will see you to discuss the operation, types of anaesthetics (see below), pain control and ask you to sign a consent form. You will have blood taken.As your Caesarean birth is an operation you may need to be screened for MRSA prior to your admission. MRSA can only be found by testing in a laboratory from swabs taken from skin, wounds or a sample of urine. Swabs are taken from the nose. This will not hurt and only takes a few minutes. If you are found to be carrying MRSA you will be contacted and given a course of treatment. If MRSA is not found you will not be contacted. Your date will be communicated with you by text or answer machine message approximately seven days in advance. This date may be changed at short notice depending on clinical need.
You will be given two Ranitidine (antacid) tablets to take before your operation. Take the tablets as prescribed: one at 10pm on the night before the operation and one at 6am on the morning of the operation.
Types of anaesthetic
Regional spinal and/or epidural anaesthesia - you will be awake for your operation, which means that one birth partner can stay with you. This is the technique used for about nine out of 10 Caesarean births at the Central Delivery Suite at Southmead Hospital.
The anaesthetist will give you an injection into your back to numb the pain sensation to the lower half of your body (epidural or spinal). In most cases, this is the form of anaesthetic that we recommend, as it is better for you and your baby. Your birth partner can stay with you in theatre if you are having this type of anaesthetic.
General anaesthesia - in some cases, it may be appropriate for you to have a general anaesthetic for your Caesarean birth. The anaesthetist will ask you to breathe some oxygen through a mask, before you are given some medicine into
a vein (a ‘drip’) that will make you drift off to sleep for the whole operation. You will be woken up after the surgery has finished and be able to see your baby as soon as possible. If you are having a general anaesthetic your birth partner will not be able to stay with you in theatre, but can be with you again when you are in the recovery area, next to the theatre.
What happens on the day of my elective (planned) Caesarean birth?
- Please remember to bring your notes and a small hospital bag containing a nappy and hat for baby and camera with you
- Do not eat anything from midnight the night before the operation
- You may drink clear water between midnight and 6am, unless you are a diabetic we recommend drinking a non fizzy sports drink with the ranitidine tablets and nothing at all after 6am
- Have a bath or shower before coming into hospital, but please do not remove hair from the surgical site on the day of surgery.
- Remove your nail varnish and do not wear any makeup or jewellery. You may wear your wedding ring but it will be taped to your finger before going to theatre
- Bring a CD with you to listen to in theatre, if you wish
- Only one birth partner is able to be with you in theatre during the Caesarean and on very rare occasions they may be asked to leave by the surgeon or anaesthetist if necessary
- Unfortunately you will not be able to use a video camera to film the birth of your baby in the operating theatre but you can bring a camera to take photos of your baby.
Elective Caesarean theatre lists normally start in the morning, but if there are emergencies on the Central Delivery Suite your operation may be delayed. Whatever happens, you will be kept well informed. Very rarely a Caesarean birth may not be performed on the planned day due to other emergencies. If this is the case then every effort will be made to ensure you are priority for the following day.
Who will be in the operating theatre?
The Caesarean birth team who will care for you in the operating theatre:
- A midwife will remain with you in the operating theatre
- One or two anaesthetists
- Anaesthetic assistant
- Obstetrician (the surgeon)
- Assistant obstetrician (the assisting surgeon)
- Midwife/nurse assisting the surgeon
- Circulatory nurse (to get equipment for surgeon and assistants)
- Sometimes a neonatal doctor (specialises in the care of babies)
- Sometimes student doctors or student midwives may be present. If you do not want students please feel free to say so.
What happens during a Caesarean birth?
The operation usually lasts 30-50 minutes. Before your operation you may be asked to wear special anti-embolism stockings to improve blood flow in your legs. A catheter will be inserted into your bladder to collect urine and keep it empty during the operation.
The theatre team will go through a health and safety checklist (World Health Organisation perioperative checklist) which is normal practice prior to all surgery. As you will be more than likely be awake due to having spinal anaesthetic you and your birth partner will be aware of this and can ask any questions you may have. Once the anaesthetist has given the obstetrician permission to start your operation, your abdomen (tummy) will be cleaned with an antiseptic lotion and a drape (sheet) applied to keep the area sterile. The drape forms a screen which means that you and your partner cannot see the operation. The screen can be lowered, if you wish, once your baby is born. You will hear various noises of people moving around in the theatre during your Caesarean.
Once born, your baby will be dried, checked over and wrapped in a blanket before being brought to you. You may at this point have ‘skin to skin’ with the baby as it helps keep the baby warm and is important with bonding and encourages the baby to be ready for a feed.
At the end of the operation your wound is closed with stitches, of which some are dissolvable and some have to be removed. A dressing will be applied to the wound on your abdomen (tummy) and very occasionally a small plastic drain (tube) is left in the wound for about 12 hours to help prevent a bruise developing. When this is ready to be removed, the midwife will gently pull it out.
When your Caesarean is completed, all drapes will be removed and you will be transferred onto a bed before going into the recovery room.
Pain control after your Caesarean will be discussed with you; tablets, suppositories (painkillers given in your back passage) and injections are used. It is important that you tell us if you are uncomfortable.